Erin Grady, M.D., plays key role in White House conference on nuclear medicine

Erin Grady, M.D., plays key role in White House conference on nuclear medicine

Erin Grady, M.D.
Erin Grady, M.D.

Erin Grady, M.D., a nuclear medicine physician at Christiana Care, played a key role in a White House conference on June 20 to explore ways to ensure a stable supply of the most commonly used radioisotope in nuclear medicine.

The radioisotope is Molybdenum-99 (Mo-99), the parent compound of Technetium 99m (Tc-99m), which is used in more than 20 million diagnostic nuclear medical procedures every year, half of which are bone scans. The other half is divided between kidney, heart and lung scans.

Dr. Grady, the only nuclear medicine physician at the conference, represented the Society of Nuclear Medicine and Molecular Imaging, where she chairs a subcommittee on third-party insurers.

Nuclear medicine is a specialty in which small amounts of radioactive materials, or tracers, are used to diagnose and treat a variety of diseases.

“The United States uses 50 percent of the world’s Mo-99, so making sure there is a domestic supply is very important,” said Dr. Grady, who plans to attend quarterly meetings in Washington, D.C. on the issue. “Shortages would have a negative impact on our ability to produce the diagnostic images we use to help patients every day. Since this agent is used so often and offers such great resolution with our gamma camera technology, it would be difficult to diagnose without it.”

Currently, the U.S. does not produce any Mo-99. Much of the compound used in the U.S. comes from Highly Enriched Uranium (HEU) from Canada. The Canadian reactor goes offline in 2016, so timing is an issue.

The White House has made the shift to Low Enriched Uranium (LEH) a priority because HEU can be used in nuclear weapons. LEH cannot be used in weapon making.

The primary source of Mo-99 made with LEH is Australia, a 24-hour flight to the east coast. Because the half-life of Mo-99 is only 67 hours, a significant portion of the substance is already gone by the time it arrives. Events that interrupt air traffic, such as the 9/11 terrorist attacks or a volcanic eruption in Iceland, shut down the supply to the U.S. altogether.

The Obama Administration supports U.S. production of Mo-99 using non-HEU materials to ensure a steady supply of the radioisotope.

This is a complex topic that also involves how patients and providers will be reimbursed. Currently, the Centers for Medicare & Medicaid Services (CMS) offer an additional $10 reimbursement for the radioisotope made with LEU. But, many third-party insurers do not yet have policies in place.

Other attendees at the conference included representatives from the White House, Department of State, National Nuclear Security Administration, Nuclear Regulatory Commission, the Office of Science and Technology Policy, the Food & Drug Administration, CMS, current industry representatives and individuals from start-up companies who want to build LEU reactors at a few locations in the U.S.